That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Saturday, October 07, 2006

Blue

Warning! Whiny post ahead! I'm in a terrible funk, and I just can't seem to shake it loose. It is my favorite time of year. The colors are bright, and the air is cool. It is beautiful here in the mountains. Hormonally, I'm still waiting for the PMS monster to go away (no, alas, I'm not pregnant). My football team is in the cellar of a mediocre conference, and I've been working really hard, but feeling like I'm getting nowhere. I was also sad to hear of a fellow OB/GYN blogger and her unexpected death. I really loved her blogging voice, and could relate so closely to the things she was enduring as an intern. She had a brilliant light, and it saddens me that it has been extinguished, I feel, too soon. It's funny, because we really don't know one another out here in the blogging world, but I find myself emotionally invested in the blogs that I read. I asked my husband to update my blog, should anything ever happen to me. I feel as though our whole lives are working toward something...the next weekend, the next vacation, the next pregnancy. We so often forget to appreciate the now. I have been trying to stop my forward thinking, just to sit back and enjoy all with which my life has been blessed.

I'm taking call this weekend for the hospital, for myself, and for OtherDoc, but tomorrow night my husband and I are going to a concert. I miss getting out amongst the living in a social setting (sans pager!) Next weekend will be the first weekend that I am not on call and not on vacation. I can't wait. I think we are going to visit some of the surrounding parks/recreation areas. The fall colors should be at their peak, and we will get to enjoy some beautiful scenery with our nature-loving daughter.

It has been a very busy week, and I've been at the hospital late a couple of nights. I've had good deliveries and not so great deliveries. One of the best deliveries was one of my post-dates patients (one I had to talk out of an elective induction) that came in naturally laboring. She walked until she was 7 centimeters, rested a bit, and then asked for an epidural. At that point it was too late because she was anterior lip and nearly ready to deliver! She delivered an 8-and-a-half pound baby without any meds. She was so thrilled. I love labors like these! My second labor patient of the day (the one that caused me to miss the live Lost premiere ) was also post-dates with oligohydramnios. She had a very large (and quite overbearing) family, and she had rotating groups of people migrating between her room and the waiting room throughout the day. She and her husband are quite pleasant, but you would not believe the way she was coddled by her family. It was if she were some kind of fragile doll. I chalked my snarkiness up to PMS, and tried to hold my tongue when person after person pressed me for a time of delivery. Her mother sidelined me and asked weather or not I thought she would be able to have a vaginal delivery, since she was "so small." I explained that she at least deserved a chance, and encouraged her mother to continue supporting her. The patient did have the rather unreasonable expectation of having no discomfort whatsoever in labor. That was unfortunate, and after she had been pushing for just a little under an hour, she begged me to "just pull it out!" I reassured her, and encouraged her to rest a while and resume pushing. The baby's presentation was right occiput posterior, but still a little too high for a vacuum or forceps. She pushed for yet another hour, and was able to bring the head down to +2 station. I applied a vacuum and rotated the baby to OA and delivered in one push. That was the good news. The bad news was that, upon delivery, the posterior shoulder tore into the perineum, and she sustained a partial fourth degree laceration. (No, she did not have an episiotomy.) Even more exciting, the spotlight chose that moment to expire, necessitating an impromptu call to maintenance. My patient rested, her legs up in the stirrups, draped strategically with blue towels, while the poor maintenance man did the fastest light bulb change on record. Talk about awkward! The repair itself actually went very well, but I feel for the discomfort she will endure in the coming weeks. Ouch!

Today I did a c-section on a woman with severe pre-eclampsia. She had been laboring for 2 days, and despite adequate contractions and every trick in the book, she never dilated past 2 centimeters. Stranger still, neither her mother nor her grandmother ever progressed in labor further than 2 centimeters! We jokingly dubbed the phenomenon the "2 centimeter curse." Luckily, she had a man-child, so he shall dodge the hereditary misfortune. Tonight I am praying for good company, some good sleep, and the return of a good mood. Perhaps I will awake tomorrow with the remnants of my funk evaporating like the mist over the mountains. I certainly hope so.

12 comments:

I feel for you. I, too, yearn to be pregnant and am fighting PMS right now. I, too, wish I could just be happy with what I have, a healthy son and a wonderful husband and a great career. I, too, have been in a funk since I learned of GM's death.

As for the man-child, I hope he wasn't really man-sized. That might explain her failure to progress, wouldn't it? :)

OMG, who was the other OB/GYN blogger? I wonder if I've read it?! There is another, but she is quite, um... pissy and I won't even share her url ;)

and ... the 4th degree. I've never seen one and hope I don't. I had a birth Friday and another Saturday and not even a skid mark on either which was refreshing because I've had my share of (nasty) labial tears lately I'd like to forget.

Dr. Whoo, just wanted to let you know that my lap turned out ok. I was anon for pelvic pain a few posts back. I had some adhesions to the bowel, peritineum?, and left fallopian tube. My dr aspirated an ovarian cyst on the left side. Strangely enough, all of my pain was right sided and all of the adhesions were on the left. My dr suspects the pulling caused pain on the right. He told me I WASN'T crazy with the pain issue, thank goodness. You didn't have an email listed. The lap has been pretty easy so far to deal with. The worse part has been nausea but we suspect that my blood sugar was low after not eating. Two doses of reglan and a dose of Zofran didn't work but a glass of juice did wonders.

Good job on your pe momma. I had that too with my first child. I have some websites she can visit for support if she needs some. As I have found out PE still bothers me to this day with the impact of it.

I definitely sympathize. For me, I can always tell I'm PMS'ing whenever I get on my pulpit of "patient non-compliance". I am extremely compassionate and understanding about patient foibles for about 24 days of the month-- but then for those PMS days I suddenly turn into the Compliance Nazi....

Y'all are the best. I just want to thank all of you for your wonderful comments! You know how to make a girl feel loved!

Hi Julie, RN~ Welcome and thanks for the good wishes! They are appreciated. Luckily, the blues are now far behind me. Hope you have a great weekend!

FD~ Too many times I read your blog and wonder if you are reading my mind. You write things that I think all the time! Kindred spirits, perhaps? I hope that you are no longer blue! As for the kiddo, he was a mere 6 pounder, I still have no plausible theory for her failure to progress.

frectis~ Didn't mean to make you worry! I've just been totally swamped! The blogger that died, by pulmonary embolus, apparently, used the blogging name "Glorified Midwife." Her blog, A Sorta Fairytale, goes from med school, through the match, to the beginning of her intern year. She seemed like someone with whom I would have gotten along. Her death just cemented that nagging feeling that our time here is too short.

Even though you never want to see one, I hope that you can get some exposure to 4th degrees so that you can learn to repair them properly. It is so important to do a correct repair!

Anon~ I am so happy to hear that your laparoscopy diagnosed (and hopefully) treated the pain with which you were suffering. Pelvic adhesive disease can be devastating. Wishing you a speedy recovery and pain-free days in the future!

moof~ Thank you for your kind sentiments. I know that the weekend will do wonders for my psyche, and music is always a good cure for that which ails! I hope that you and yours are happy and well.

medstudentitis~ It is truly amazing, the blogging community. How odd that we feel so close to people thousands of miles away! GM will be truly missed.

On a lighter note, the concert was a blast! Happy Belated Birthday! I promise to get to your blog to comment soon!

a bohemian road nurse~ It is awful what those raging hormones can do to your patience quota. Mine is low to begin with, but at PMS time, just lay low and stay out of the way! Thanks for reading, and I'm looking forward to checking out your blog.

frectis~ I'm not sure if anyone actually posted condolences on her blog, so it still looks like she is just taking a long posting break. I haven't looked at the site in a few days. I found out via Fat Doctor, who got an email from GM's mother.

So if you get worse than a 2nd degree at a home birth, do you have to pack the mother up and go to the hospital to get the lac repaired? That sucks. I guess a lot of homebirth moms are second time (or more) mothers, too, making serious lacerations less likely?

It's complicated (bah!) because I'm a direct-entry midwife, not a nurse-midwife so our laws vary by state. Some states legal, some states aren't. Then of the legal states they decide what the scope of practice is. Some states have mandatory insurance reimbursement, some contraceptives, suturing, meds, physician supervision... and some like mine have the bare minimum of privilege. Our state requires we know how to suture by virtue of our educational and clinical requirements, but doesn't allow us to do it! It's a law change we hope to be working on this next year. So you bet your sweet perineum we do all we can to avoid tears!